Crosswalk

PACE Quality Data Monitoring and Reporting
Crosswalk for CMS-10525--OMB 0938-1264
2023

2020 (Former Version)

2021 (Current Version)

Type of
Change

PACE Quality Data
Monitoring & Reporting
Guidance

PACE Quality Data
Monitoring &
Reporting Guidance

The introductory sentence
on page 1 erroneously
references § 460.140(d) as a
supporting regulation for the
data collection.

The regulatory citation
was corrected to §
460.130(d),

Revision The original reference
to § 460.140(d) was
erroneous, and this
change will now
reference the correct
regulatory citation.

“This document provides an
overview of the Programs of
All Inclusive Care for the
Elderly (PACE) quality
monitoring and reporting
requirements outlined in
Title 42 of The Code of
Federal Regulations (CFR),
§§460.140(d),
460.200(b)(1), 460.200(c)
and 460.202.”

“This document
provides an overview of
the Programs of All
Inclusive Care for the
Elderly (PACE) quality
monitoring and reporting
requirements outlined in
Title 42 of The Code of
Federal Regulations
(CFR), §§460.130(d),
460.200(b)(1),
460.200(c) and
460.202.”

PACE Quality Data
Monitoring & Reporting
Guidance

PACE Quality Data
Monitoring &
Reporting Guidance

Emergency Room Visit(s):

Reason for Change

Revision The incident type
Emergency Room
Visits was revised to
now include “and/or
Urgent Care.”
Emergency Room and/or
Urgent Care Visit(s)

Page 1 of 4

Burden
Change
No
impact.

No
impact.

PACE Quality Data Monitoring and Reporting
Crosswalk for CMS-10525--OMB 0938-1264
2023

2020 (Former Version)

2021 (Current Version)

Type of
Change

PACE Quality Data
Monitoring & Reporting
Guidance

PACE Quality Data
Monitoring &
Reporting Guidance

Reporting Thresholds:
Enrollment Data

Reporting Thresholds:
Enrollment Data

Revision The reporting
thresholds for the
enrollment data
category were reordered to be
consistent with the
format of HPMS.
And,
To promote
consistency and
accuracy, CMS
provided clarification
on reporting deaths
and replaced the term
“total census” with
“total enrollments.”

•

•
•
•

•
•

Data is collected at an
organizational level
until the last day of the
quarter and includes:
Total Census;
Total New Enrollments;
Enrollment Denials
(prospective enrollees)
including the denial date
and denial reason;
Total Disenrollments
(does not include
deaths); and
Total Deaths.

•

•
•
•

•
•

Data is collected at
an organizational
level until the last
day of the quarter
and includes:
Total Enrollments;
Total New
Enrollments;
Enrollment Denials
(prospective
enrollees) including
the denial date and
denial reason;
Total Disenrollments
(does not include
deaths); and
Total Deaths.

Note: Participant deaths
should be reported as a
“death” and not as a
“disenrollment” from
PACE.

Page 2 of 4

Reason for Change

Burden
Change
No
impact.

PACE Quality Data Monitoring and Reporting
Crosswalk for CMS-10525--OMB 0938-1264
2023

PACE Quality Data
Monitoring & Reporting
Guidance

PACE Quality Data
Monitoring &
Reporting Guidance

Reporting Thresholds:
Immunizations

Reporting Thresholds:
Immunizations

For each participant, the PO
provides the following
information regarding
vaccinations:
• The total number of
participants enrolled
during the reporting
period (including all
disenrolled and
deceased participants);
• The total eligible to
receive immunization;
• The number of vaccines
administered by the PO
to eligible participants;
• The total number
eligible participants who
did not receive the
Pneumococcal/Influenza
for the following
reasons:
o Medically
contraindicated;
o Prior immunization;
o Refused;
o Vaccine
unavailable; or
o Missed opportunity
(vaccine available
but was not
administered); and
o The number of
participants who
received the vaccine
and reported or had
a reaction.

For each participant, the
PO provides the
following information
regarding vaccinations:
• All participants
enrolled during the
reporting period
(including new, current,
disenrolled and deceased
participants);
• The total eligible to
receive immunization;
• The number of
vaccines administered
by the PO to eligible
participants;
• The total number
eligible participants who
did not receive the
Pneumococcal/Influenza
for the following
reasons:
o Medically
contraindicated;
o Prior immunization;
o Refused;
o Vaccine unavailable;
or
o Missed opportunity
(vaccine available but
was not administered);
and
o The number of
participants who
received the
vaccine and
reported or had a
reaction.

Page 3 of 4

Revision To promote
consistency and
accuracy, CMS
provided clarification
that immunizations
are reported on all
participants, including
new, current,
disenrolled and
deceased participants.

No
impact.

PACE Quality Data Monitoring and Reporting
Crosswalk for CMS-10525--OMB 0938-1264
2023

2020 (Former Version)

2021 (Current Version)

Type of
Change

PACE Quality Data
Monitoring & Reporting
Guidance

PACE Quality Data
Monitoring &
Reporting Guidance

Reporting Thresholds:
Infectious Disease
Outbreak

Reporting Thresholds:
Infectious Disease
Outbreak

• Resulted in death; or
All incidents that are
reportable to the respective
State or County public
health authority, have three
or more cases and are linked
to the same infectious agent
within the same time frame.
Some situations may require
additional reporting to the
CDC.

•
•

Revision To promote
consistency and
accuracy, CMS
provided clarification
on the thresholds for
reporting an infectious
disease outbreak.
Specifically, POs are
required to report an
infectious disease
outbreak if one or
more of the criteria
listed is met.

•

Resulted in death; or
All incidents that are
reportable to the
respective State or
County public health
authority; or
Have three or more
cases and are linked
to the same
infectious agent
within the same time
frame. The time
frame is dependent
on the infectious
agent.

Note: Some situations
may require additional
reporting to the CDC.

Page 4 of 4

Reason for Change

Burden
Change
No
impact